Victorian Numbered Regulations

POWERS OF ATTORNEY AMENDMENT REGULATIONS 2017 (SR NO 17 OF 2017) - REG 6

For Form 2 in Schedule 1 to the Principal Regulations substitute —

" FORM 2

REVOCATION BY PRINCIPAL OF ENDURING POWER OF ATTORNEY OR APPOINTMENT OF ATTORNEY/ALTERNATIVE ATTORNEY

Regulation 6

Name of principal:

Address of principal:

I revoke under section 44 of the Powers of Attorney Act 2014 :

*the enduring power of attorney made by me on [ insert date made ].

*the appointment of my attorney(s) [ insert name (or position) of one or more attorneys ] of [ insert address(es) of attorney(s) ] under the enduring power of attorney made by me on [ insert date made ].

*the appointment of my alternative attorney(s) [ insert name (or position) of one or more alternative attorneys ] of [ insert address(es) of alternative attorney(s) ] for [ insert name of attorney(s) ] under the enduring power of attorney made by me on [ insert date made ].

Signed : [ signature of principal or person signing at the direction of (on behalf of) the principal ]

*I sign this instrument of revocation in the presence of and at the direction of the principal.

*Name of person signing at direction of principal:

*Address of person signing at direction of principal:

Date:

CERTIFICATE OF WITNESSES

Witnessed by:

Name of first witness:

Address of first witness:

Name of second witness:

Address of second witness:

Each witness certifies that:

*the principal appeared to freely and voluntarily sign this instrument in my presence; and

*[ If witnessing another person signing at the direction of and in the presence of the principal ] in my presence, the principal appeared to freely and voluntarily direct the person to sign for the principal and that person signed this instrument in my presence and in the presence of the principal; and

              •     at that time, the principal appeared to me to have decision making capacity to revoke this enduring power of attorney; and

              •     I am not an attorney under this enduring power of attorney; and

              •     I am not a relative of the principal or of an attorney under the enduring power of attorney; and

              •     I am not a care worker or accommodation provider for the principal.

*[ If witnessing another person signing at the direction of and in the presence of the principal ] I am not the person who is signing at the direction of the principal.

Signed :

First witness: [ signature of first witness ]

*Qualification: [ if first witness is acting as a medical practitioner or person authorised to witness affidavits ]

Second witness: [ signature of second witness ]

*Qualification: [ if second witness is acting as a medical practitioner or person authorised to witness affidavits ]

Date:

*Delete if not applicable.".